Project Summary The purpose of this project is to complete the development of a statewide, county-based quality improvement (QI) and community health improvement infrastructure that will help primary care practices become patient-centered medical homes and to improve the health of Oklahomans. We will also provide assistance to three other states, helping them to create similar infrastructures. The QI approach developed by Oklahoma researchers and tested in Oklahoma practices has now been implemented by several state agencies and organizations, many organizations throughout the country, incorporated into the national Accountable Care Act, and specified in this Request for Applications. Oklahoma received federal grants for an HIT Regional Extension Center (REC) and for Health Information Exchange (HIE). The Oklahoma HIE Trust, the applicant for this award, was established to promote HIE throughout the state. An AHRQ- funded Regional Health Information Organization, SMRTNet, has already connected a variety of health data sources throughout the state. County-level health improvement activities have emerged and are being supported by the Department of Health, the HIT REC, and SMRTNet. The Area Health Education Centers are prepared to become Regional Coordinating Centers. Assembling a cohesive, sustainable infrastructure from the existing pieces will require: 1) clinician education, mobilization, and input; 2) alignment of the principal organizations and QI providers; 3) an organizational blueprint including administrative structure, bylaws, policies and procedures, job descriptions, communication channels, reporting requirements, and formation of county-based non-profits; 4) a plan for recruiting, training, and certifying practice facilitators; 5) development of a process for identification and prioritization of improvement projects; and 6) identification of sustainable funding to supplement project-specific funding. We have chosen three dissemination states, Arkansas, Pennsylvania, and Oregon, with well-developed statewide QI activities. Money has been budgeted for our team to travel to each state, for a statewide stakeholders meeting, and for leaders in each state to conduct the individual and group meetings required to align stakeholder groups. Communication between the four states will begin as soon as the award has been received and continue throughout the project.